'When you hear hoofbeats, think of horses not zebras' - the old adage is well-known to GPs but what should you do when faced with a zebra, not a horse? Consultant cardiologist Professor Robert Tulloh and GP Dr Louise Tulloh kick off our new series with their advice on how to catch Kawasaki disease in general practice.

A rallying cry for unity among GPs

3 September 2009

As the GP profession stands on the brink of an almightly political split, we launch a campaign to reconcile the two groups' differences and enable the BMA to represent both their interests successfully

As the GP profession stands on the brink of an almightly political split, we launch a campaign to reconcile the two groups' differences and enable the BMA to represent both their interests successfully

Many of the profession's leaders have been off on well-earned summer breaks during August, but as they returned last week recent events will have jolted them rapidly back into work mode. Politically, general practice is in some degree of turmoil. Pulse's revelation in our last issue that salaried GPs and locums have lost faith in the BMA and are planning to set up camp with the Medical Practitioners' Union has left the profession wondering what the future holds. Are the days of general practice as a single, unified entity coming to the end? And if so, what will that mean for the ability of the profession to argue its case with the Government, and to speak up strongly on behalf of patients?

Our survey this week of more than 500 GPs – partners, salaried doctors and locums – delivers a clear message about how the profession views the growing divisions in its ranks. General practice yearns to be made whole, with as many as three-quarters of respondents warning the widening split is damaging for the profession. But that does not translate into a universal rejection of the proposal by the National Association of Sessional GPs to throw its lot in with the MPU. Partners regard the plan with concern and in some cases horror, but salaried GPs and locums seem to view it as the only realistic way of evening up odds they feel are stacked against them.

If GPs and their leaders are grappling over how to respond to the new developments, it has been a difficult call for Pulse too. As a magazine for the whole of general practice, it is not our job to side with one faction against another, but rather to champion ways of bringing the profession back together. The campaign we launch this week – One Voice – aims to promote unity, open debate about the profession's future and a new settlement between partners and salaried GPs. In particular, we will be campaigning on behalf of GPs for policies to address the route cause of much of the discontent – the acute shortage of partnership positions.

Partnerships started drying up after the introduction of the 2004 GMS contract, which broke the link between payments to practices and the number of partners serving a patient population. Contracts set the financial framework under which a profession works. It is both unfair and pointless to blame individual GP principals for failing to create partnerships when they have only been working within the financial constraints set by the Government, including successive squeezes on practice income. But the financial framework must now change, whether through alterations to the national contract, or locally negotiated incentives, to once more make it profitable to appoint a new partner rather than a new salaried GP.

Contractual changes alone will not be enough to achieve unity. A substantial number of GPs will remain salaried, some by choice, and they must be assured stronger representation. If the BMA is unable to deliver that, then it can have no complaints if salaried GPs opt for the MPU instead. And the BMA must resist the temptation for an inward-looking debate. We need a new forum for all of general practice, including the NASGP and the RCGP, to talk through differences and agree a new, and unified, way forward for the profession.